Exploring the effect of pre-connected pressure sensor on ultrasound-guided radial artery puncture in patients with gastrointestinal tumors

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Method Seventy-five eligible patients undergoing elective gastrointestinal tumor surgery were randomly divided into two groups: the pre-connected pressure sensor puncture group (group P = 38) and the conventional puncture group (group C = 37). The patients' vital signs were monitored upon entering the room, and a senior anesthesiologist performed the radial artery puncture and catheterization for both groups. The radial artery puncture catheterization was guided by ultrasound in both groups, Prior to the puncture, patients in group P were pre-connected to the pressure sensor. After zeroing and exhausting, the radial artery puncture catheter was performed under ultrasound guidance. with group C undergoing direct ultrasound-guided puncture catheterization. The success rate of first puncture catheterization, puncture time, puncture times, and puncture failure rate were recorded. Result The success rate of radial artery catheterization on the first attempt was significantly higher in group P compared to group C ( P < 0.05). Furthermore, group P demonstrated a decrease in both arterial punctures and VAS pain scores. ( P < 0.05). Conclusion Pre-connecting a pressure sensor when performing radial artery puncture and catheterization in patients with gastrointestinal tumors can enhance the success rate of radial artery puncture and catheterization under ultrasound guidance. pressure sensor radial artery puncture gastrointestinal tumors ultrasound radial artery catheterization Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Continuous invasive blood pressure monitoring and blood gas analysis are essential for critically ill patients and major operations [ 1 – 2 ]. The radial artery, due to its fixed position, superficial nature, and low complication rate, is often chosen as the primary site for arterial puncture [ 3 ]. As radial artery puncture becomes more prevalent, it is crucial to establish a safe and effective puncture method. The development of clinical ultrasound technology has allowed for the full utilization of the ultrasound visualization of the radial artery during puncture. Numerous research studies [ 4 – 6 ] have demonstrated that ultrasound technology offers a higher success rate of catheterization and lower complications compared to blind puncture methods. At present, the application of arterial puncture ultrasound technology is more in-plane and out-of-plane techniques. Currently, in-plane and out-of-plane techniques are commonly used in arterial puncture ultrasound technology. A meta-analysis conducted in 2022 indicated that there is no significant difference in the success rate of first-time arterial puncture between these two techniques [ 7 ]. Hence, both techniques can be employed for arterial puncture. However, as ultrasound provides two-dimensional images, there is a possibility of slice thickness artifacts in the plane. Observing the puncture needle within the blood vessel may suggest that it is close to or has penetrated the vessel wall. On the other hand, out-of-plane ultrasound techniques also have limitations as they struggle to accurately identify the position of the needle tip and needle body. Consequently, the success rate of the initial puncture of the radial artery under ultrasound guidance remains somewhat restricted [ 8 ]. The depth of the artery from the skin can also impact the relationship between the puncture needle and the artery, leading to a decrease in the success rate of puncture catheterization [ 9 ]. Furthermore, the complexity of ultrasound technology has hindered its widespread use, as it requires expertise to operate. As a result, blind puncture catheterization is still considered a dependable and often preferred method in clinical practice [ 10 ]. The use of ultrasound technology is only considered after repeated puncture and catheterization failures. At this time, the existing puncture injuries, vasospasm, and hematoma may greatly increase the difficulty of puncture and catheterization [ 11 – 12 ]. Despite the presence of ultrasound technology, researchers both domestically and internationally have continued their efforts to improve the success rate of radial artery puncture and catheterization. Various methods have been explored, including increasing the diameter of the radial artery [ 13 ], utilizing ultrasound probe marking[ 14 ], selecting the appropriate angle for the ultrasound probe[ 15 ], investigating new ultrasound technologies[ 16 ], employing laser-assisted technology[ 17 ], and utilizing nerve block methods[ 18 – 20 ]. Ultrasound-guided radial artery puncture involves two main steps: puncture and catheterization. The primary challenge in both steps lies in accurately positioning the puncture needle within the arterial vessel and ensuring the stability of the needle core throughout the catheterization process. The current arterial puncture needle has no imaging effect, which also increases the difficulty of positioning the puncture needle under ultrasound, and the diameter of the radial artery is not large [ 21 – 22 ]. The puncture needle is too deep or too shallow, which may lead to the failure of catheterization. At the same time, it is regrettable that most operators usually abandon ultrasound during catheterization, which is completely blind catheterization. Ultrasound technology is more for the puncture process than the catheterization process, and the movement of the needle core caused by any reason All may lead to failure of catheterization. It is worth noting that the catheter can sense hemodynamic changes in the artery [ 23 ], and the slight depth change of the puncture needle can be monitored, which is also the basis of the invasive arterial waveform [ 24 ], so it can be predicted in advance. Connect the pressure sensor to observe the pressure waveform changes of the radial artery for judgment, and at the same time, it can be determined whether the punctured blood vessel is an artery. Therefore, we propose a hypothesis, pre-connect the pressure sensor, observe the changes in the arterial pressure waveform, guide the puncture of the radial artery under ultrasound, and explore its impact on the first-time success rate of radial artery puncture. Materials and methods 2.1 Materials The equipment used in this study included the Mindray TE7 color Doppler ultrasound system (Shenzhen Mindray Biomedical Electronics Co., Ltd.). Other supplies included a 1ml syringe, 5ml syringe, 500ml 0.9% sodium chloride injection, sterile gauze, Medical transparent dressing film, pressure sensor, heparin sodium injection, 20G Introcan-W puncture needle, sterile hole towel, sterile gloves, disposable sterile ultrasound probe protective cover, and medical ultrasound probe disinfection gel. 2.2 Methods 2.2.1 Study design This is an open single center randomized clinical trial conducted in the People's Hospital of Ganzhou City, China. This Randomized controlled trial was approved by the Ethics Committee of Ganzhou People's Hospital, with the consent letter No. TY-ZKY2023-019-01. Following the principles of the Declaration of Helsinki, Clinical trial registration (Registration No.: ChiCTR2400083806) was completed. all patients voluntarily signed the informed consent. From March 2023 to July 2023, 82 ASAII-III patients undergoing elective gastrointestinal tumor surgery who were scheduled to undergo radial artery catheterization in the operating room of Ganzhou People's Hospital were selected and divided into two groups: pre connected pressure sensor puncture group (group P = 38) and conventional ultrasound puncture group (group C = 37). Inclusion criteria for this study included individuals aged 40 to 74 years old, with a negative result on the left hand modified ALLEN test, and without any signs of infection or trauma on the local skin of the left radial artery. Exclusion criteria comprised of the absence or malformation of the left radial artery, peripheral vascular disease of the left upper extremity, abnormal coagulation function. Cases that did not meet the inclusion criteria or did not undergo radial artery puncture as per the predetermined plan were excluded from the study. Additionally, participants who did not cooperate or voluntarily withdrew during the implementation process were considered drop-outs. Out of the initial 82 selected patients, only 75 met the inclusion criteria and were randomly divided into two groups: the experimental group (group P) with 38 cases and the control group (group C) with 37 cases. The random number table method was used for the allocation (Fig. 1 ). 2.2.2 Preparation before puncture Preparation before puncture, all patients underwent the modified Allen's test. A 20G Introcan-W puncture needle was selected and patients were positioned in a supine position, palms facing upwards, and wrists elevated. The wrist joints were maintained in a hyperextended state. Lidocaine was drawn from a 1ml syringe and injected. The solution was prepared by extracting 2500U of heparin sodium using a 5ml syringe and mixing it with 500ml of 0.9% sodium chloride injection to create a heparin sodium dilution of 2U/ml. The pressure sensor was connected and zeroed by exhausting it. 2.2.3 Puncture process Before arterial puncture, povidone iodine was used for disinfection. and the center point was the strongest pulse of the radial artery 1 cm proximal to the radial styloid process, and the range was greater than 10 cm. After disinfection, a sterile drape was spread, and the same experienced anesthesiologist with a senior professional title performed radial artery puncture and catheterization in both groups. The puncturer wore gloves and applied gel to the high-frequency linear array ultrasound probe. The frequency range of the ultrasound probe was set at 5–13 MHz, and the out-of-plane ultrasound technique was used. Once the puncture point was determined, the position of the probe was adjusted to ensure clear imaging of the radial artery at the center of the screen. Local anesthesia was administered with the assistance of ultrasound, followed by arterial puncture performed under ultrasound guidance. The needle shaft was maintained at an angle of 30–45° to the skin. Before performing the puncture in group P, Connect the pressure sensor to the puncture needle. After that, the zero should be adjusted again to exhaust the air. During the puncture, ensure that the needle tip is positioned in the middle of the arterial vessel. Depress the puncture needle handle and continue advancing the needle for approximately 0.5cm. Fine-tune the position until a continuous pattern is displayed on the monitor. Arterial catheterization should only be performed when the needle tip remains in the center of the arterial vessel. Ultrasound guidance is not used during the catheterization process. The right hand should keep the needle core steady, while the left hand maintains continuous and regular arterial waveforms on the monitor throughout the catheterization process. If the continuous and regular arterial waveform cannot be maintained, adjustments should be stopped until the waveform is restored. Once the catheter is successfully placed, the needle core connected to the pressure sensor should be removed and the sensor should be connected to the catheter. If the catheter placement is unsuccessful, the puncture will continue to be attempted in the same manner until it is successful or the maximum number of attempts is reached as prescribed (Fig. 2 ). In group C, the radial artery puncture was performed directly under ultrasound guidance, without pre-connection of the pressure sensor. When the needle tip reached the center of the artery, the needle handle was depressed, and the needle continued to advance for about 0.5 cm. Blood returned from the puncture needle. Fine-tuning the needle saw blood return or The puncture needle has been filled with blood but the needle tip is still in the middle of the arterial vessel under ultrasound, At this point, allowing for the insertion of the catheter with the left hand while the needle core was fixed with the right hand. Ultrasound guidance was not used during the catheterization process. If the catheter was successfully placed, it could be connected to the sensor. If not successful, the radial artery puncture procedure would be repeated in the same manner until success or until the prescribed number of punctures was exceeded (Fig. 3 ). After successful puncture, patients in both groups were secured with a Medical transparent dressing film to fix the puncture needle catheter. Invasive arterial pressure monitoring could then be performed after calibration and exhaust. All patients were required to record the number of radial artery punctures. If catheterization was unsuccessful after three punctures, it was considered a failure and no further punctures were attempted [ 16 ]. The time from the first puncture needle piercing the skin to successful catheterization was recorded. Additionally, the time between the first puncture needle piercing the skin and the third catheterization failure was noted. The VAS score of radial artery puncture pain, as well as the first success rate and the failure rate, were also recorded. 2.3 Observation indexes This study aimed to investigate the success rate of radial artery puncture for the first time in two groups of patients. The research also examined secondary indicators such as the frequency and time of radial artery puncture, failure rate, pain VAS score, incidence of vasospasm, and incidence of subcutaneous hematoma in the two groups. Additionally, the diameter, depth of radial artery at the puncture point, and PI (Perfusion Index) of the thumb on the puncture side were measured in both groups. General information including age, gender, height, weight, body temperature, preoperative platelets, preoperative hemoglobin values, mean arterial pressure, heart rate, ASA classification, surgical site, and oxygen saturation were recorded for both groups of patients. 2.4 Sample size and statistical analysis Based on the previous pre-experiment, the success rate of radial artery puncture for the first time in group P was 90%, whereas in group C it was 62%, as reported in the existing literature [ 8 ]. Assuming a type I error of 0.05 and an efficacy of 0.80, a minimum research sample size of 66 individuals was calculated. To account for potential eliminations due to changes in clinical status, a total of 82 patients were initially recruited for the study. Categorical data were represented as numbers or percentages, while quantitative data exhibiting a normal distribution were presented as means and standard deviations. Parametric tests were employed for data with a normal distribution, whereas nonparametric tests were utilized for data without a normal distribution. Categorical data were analyzed using Chi-square tests and Fisher's probability. A p-value of less than 0.05 was considered statistically significant. All data were analyzed using the Statistical Package for the Social Sciences 23.0 (SPSS 23.0). Results 3.1 Study population There was no significant difference between the two groups in age, gender, height, weight, PLT, Hb, MAP, HR, ASA, SPO 2 ( P > 0.05). (Table 1 ) Table 1 Demographic and perioperative characteristics. Variables Group P (n=38) Group C (n=37) P Age 60.578 ± 7.543 61.027 ± 7.907 0.803 Height(cm) 162.368 ± 8.406 161.783 ± 7.424 0.751 Weight(kg) 59.684 ± 12.265 59.797 ± 12.829 0.969 PLT(10 9 /L) 232.973 ± 62.592 226.297 ± 59.825 0.638 Hb(g/L) 117.526 ± 16.260 119.081 ± 16.773 0.685 MAP(mmHg) 91.657 ± 9.168 88.891 ± 8.078 0.170 HR(bmp) 73.842 ± 8.547 71.973 ± 8.542 0.347 ASA II/III 35/3 31/6 0.451 SPO 2 (%) 97.973 ± 1.479 97.891 ± 1.629 0.820 Gender Male Female 24 14 30 7 0.084 PLT, Platelet; Hb, Hemoglobin; MAP, Mean arterial pressure; HR, heart rate; ASA, American Society of Anesthesiologists. 3.2 secondary outcomes There was no statistically significant difference between the two groups of patients in the diameter, depth, and PI of the radial artery at the puncture point during radial artery puncture ( P > 0.05). The average number of radial artery punctures in group P and group C were 1.210 and 1.567, respectively ( P 0.05). The failure rates of arterial puncture in the two groups were 5.26% and 13.51%, respectively ( P > 0.05). The incidence of subcutaneous hematoma caused by radial artery puncture in Group P and Group C was 10.52% and 32.43%, respectively ( P < 0.05), and the average VAS score of pain during puncture was 1.894 and 2.621, respectively ( P < 0.05), all of which were statistically significant. (Table 2 ) Table 2 secondary, and post hoc outcomes. Variables Group P (n=38) Group C (n=37) T/χ 2 P Secondary outcomes Diameter (mm) 25.947 ± 3.958 24.405 ± 3.013 1.894 0.062 Depth (mm) PI 24.000 ± 5.422 4.527 ± 1.741 21.621 ± 7.994 5.065 ± 1.449 1.511 -1.455 0.135 0.150 Average puncture times 1.210 ± 0.576 1.567 ± 0.867 -2.093 0.040 Average puncture time (s), median (IQR) 30.0(25.0-36.2) 35.0(28.5–120) 0.072 Puncture failure rate (%) 2/38(5.26%) 5/37(13.51%) 0.691 0.406 subcutaneous hematoma (%) 4/38(10.52%) 12/37(32.43%) 5.361 0.021 PI, Perfusion Index ; VAS, Visual Analogue Scale ; IQR, interquartile range 3.3 Primary outcomes The success rates of the first radial artery puncture in Group P and Group C were 86.84% and 67.56%, respectively ( P < 0.05), and the difference was also statistically significant. (Fig. 4 ) Discussion This study aims to investigate the impact of pre-connecting a pressure sensor to the puncture needle on the success rate of ultrasound-guided radial artery puncture and catheterization in patients with gastrointestinal tumors. The objective is to assist anesthesiologists in improving their performance of ultrasound-guided radial artery puncture during tube surgery. The study results showed that the success rate of initial radial artery puncture in group P was significantly higher ( P < 0.05) compared to group C. In evaluating the radial artery puncture process of two groups of patients, it was observed that the P group had a lower number of punctures compared to the C group ( P 0.05), suggesting that the new technology does not result in longer procedure time due to lack of proficiency. This indicates that the technology is highly reproducible and easy to understand. Regarding the failure rate of catheterization, although the P group had a lower failure rate compared to the C group, the difference was not statistically significant ( P > 0.05). This finding is consistent with the low clinical reality of failure rate in radial artery catheterization under ultrasound. In summary, it can be seen that patients in group P had fewer local anesthesia due to failure of puncture catheterization. Some studies [ 25 – 26 ] have shown that local anesthesia with lidocaine before radial artery puncture may have caused higher pain. the incidence of vasospasm, and repeated use of lidocaine may lead to tolerance, poor analgesic effect, and may also reduce the success rate of radial artery puncture and catheterization. At the same time, the complications of subcutaneous hematoma and pain in patients in group P were significantly reduced ( P <0.05), which was also related to a higher success rate of arterial puncture and catheterization[ 27 ]. Patients suffer less pain from radial artery puncture and have a higher degree of cooperation, which may also increase the success rate of puncture and catheterization. Improving the success rate of radial artery puncture catheterization under ultrasound is a pressing issue that needs to be addressed scientifically. Although a study [ 28 ] has utilized in-plane and out-of-plane ultrasound techniques to enhance the accuracy of needle placement, the combined use of these two techniques may result in more intricate ultrasound applications. However, it needs to be clarified that the purpose of puncture catheterization is to obtain continuous arterial pressure monitoring and blood gas analysis at any time. The purpose of puncture catheterization is to obtain continuous arterial pressure monitoring and blood gas analysis. However, during the puncture process, it is difficult to immediately determine the position of the puncture needle after it enters the blood vessel. This often leads to the arterial blood instantly filling the puncture needle and difficultly judge whether the puncture needle is in the artery by returning blood [ 29 ]. and the needle core needs to be kept still during the catheterization process, so the operator needs both hands to perform the catheterization process, At this point, there is no extra hand to control the ultrasound probe. In order to reduce manpower output, most people choose to abandon ultrasound for blind catheterization, At this time, whether the needle core is stable in the artery is often the key factor for successful catheterization. The function of the pressure sensor is to sense hemodynamic changes [ 30 – 31 ]. It generates regular arterial waveforms and continuous invasive arterial pressure values on the monitor. Additionally, it can monitor the position of the puncture needle and the arterial vessel, providing continuous and objective monitoring. Previous studies have confirmed that changes in the blood pressure waveform can guide the placement of the Swan-Ganz floating catheter [ 32 ]. Therefore, this feature allows for pre-connection of the pressure sensor with the puncture needle in advance. This aids ultrasound in determining the position of the puncture needle and provides continuous assistance for radial artery puncture, both with and without ultrasound guidance. The study has certain limitations that should be acknowledged. Firstly, our inclusion criteria excluded patients with abnormal coagulation function, and there is a lack of research on patients with coagulation dysfunction. Therefore, further exploration is needed to determine the applicability of the conclusions of this study to patients with coagulation dysfunction. Additionally, there may be variations in evaluation due to different pain thresholds among patients during radial artery puncture, which could potentially influence the pain score. Conclusions When performing radial artery puncture and catheterization in patients with gastrointestinal tumors, the use of pre-connected pressure sensors can enhance the success rate of radial artery puncture and catheterization under ultrasound guidance. Declarations Acknowledgements. —the authors would like to thank all the reviewers who participated in the review. Authors’ contributions. —All authors read and approved the final version of the manuscript. Funding. —This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials. —The datasets generated and/or analyzed during the current study are not publicly available before publication of our study, but are available from the corresponding author on reasonable request. Conflicts of interest. —The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript. 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Pressure-guided positioning of bicaval dual-lumen catheters for venovenous extracorporeal gas exchange. Intensive Care Med. 2013 Jan;39(1):151-4. Additional Declarations No competing interests reported. Supplementary Files Highlights.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4427025","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308317667,"identity":"d8ac712d-bad4-4096-8a46-300021820e51","order_by":0,"name":"Weibo Zhong","email":"","orcid":"","institution":"The People's Hospital of Ganzhou","correspondingAuthor":false,"prefix":"","firstName":"Weibo","middleName":"","lastName":"Zhong","suffix":""},{"id":308317668,"identity":"aeb4f42c-4890-4ae8-a716-80bc385c53c7","order_by":1,"name":"Qiaoling Weng","email":"","orcid":"","institution":"the Second Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Qiaoling","middleName":"","lastName":"Weng","suffix":""},{"id":308317669,"identity":"9e81fa18-c25c-4a16-a3d4-66737c5e6bb7","order_by":2,"name":"Qiao Yang","email":"","orcid":"","institution":"The Maternal and Child Health Hospital of Ganzhou City","correspondingAuthor":false,"prefix":"","firstName":"Qiao","middleName":"","lastName":"Yang","suffix":""},{"id":308317672,"identity":"40235c8d-e124-4d69-abd2-1903f358d1c8","order_by":3,"name":"Xianwei Jin","email":"data:image/png;base64,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","orcid":"","institution":"Nanchang University","correspondingAuthor":true,"prefix":"","firstName":"Xianwei","middleName":"","lastName":"Jin","suffix":""},{"id":308317675,"identity":"9d4ecaa2-f5fd-4a94-baae-c3e274c7db0c","order_by":4,"name":"Weihua He","email":"","orcid":"","institution":"Wuhan Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weihua","middleName":"","lastName":"He","suffix":""}],"badges":[],"createdAt":"2024-05-15 19:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4427025/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4427025/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58086121,"identity":"0bcabd71-b88d-4796-949f-c9b278018a86","added_by":"auto","created_at":"2024-06-11 02:46:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":431298,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4427025/v1/d56b829c9f17427f5d7f43a2.png"},{"id":58086120,"identity":"118d1b51-c818-48ab-9dc5-355cfbbb569f","added_by":"auto","created_at":"2024-06-11 02:46:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":493599,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOperation flowchart of patients in Group P\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4427025/v1/5d8f6770d48f68fc8d5b990e.png"},{"id":58086123,"identity":"6d27190f-86b5-4238-bee7-3fcc38f6819c","added_by":"auto","created_at":"2024-06-11 02:46:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":404633,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOperation flowchart of patients in Group C\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4427025/v1/9c565006ebff832e65fefac3.png"},{"id":58086122,"identity":"eb3bddc3-4f8c-4f7e-a3ca-6bc6152ffa41","added_by":"auto","created_at":"2024-06-11 02:46:56","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":75606,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ethe difference in first puncture success rate between Group P and Group C，*\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e ＝0.046.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4427025/v1/a0cf1071bf56796b485acb13.png"},{"id":63777862,"identity":"e7a28b46-7104-4d4c-b872-1e33d4d07ec4","added_by":"auto","created_at":"2024-09-02 09:11:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2416494,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4427025/v1/7b191bcd-7181-4cb8-933c-a62e1762eb82.pdf"},{"id":58086119,"identity":"2a8fbcde-2a69-4d2a-a7e1-3119b18f3301","added_by":"auto","created_at":"2024-06-11 02:46:56","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23355,"visible":true,"origin":"","legend":"","description":"","filename":"Highlights.docx","url":"https://assets-eu.researchsquare.com/files/rs-4427025/v1/17d77e52e02dd40e458d4d61.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the effect of pre-connected pressure sensor on ultrasound-guided radial artery puncture in patients with gastrointestinal tumors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eContinuous invasive blood pressure monitoring and blood gas analysis are essential for critically ill patients and major operations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The radial artery, due to its fixed position, superficial nature, and low complication rate, is often chosen as the primary site for arterial puncture [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As radial artery puncture becomes more prevalent, it is crucial to establish a safe and effective puncture method. The development of clinical ultrasound technology has allowed for the full utilization of the ultrasound visualization of the radial artery during puncture. Numerous research studies [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] have demonstrated that ultrasound technology offers a higher success rate of catheterization and lower complications compared to blind puncture methods.\u003c/p\u003e \u003cp\u003eAt present, the application of arterial puncture ultrasound technology is more in-plane and out-of-plane techniques. Currently, in-plane and out-of-plane techniques are commonly used in arterial puncture ultrasound technology. A meta-analysis conducted in 2022 indicated that there is no significant difference in the success rate of first-time arterial puncture between these two techniques [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Hence, both techniques can be employed for arterial puncture. However, as ultrasound provides two-dimensional images, there is a possibility of slice thickness artifacts in the plane. Observing the puncture needle within the blood vessel may suggest that it is close to or has penetrated the vessel wall. On the other hand, out-of-plane ultrasound techniques also have limitations as they struggle to accurately identify the position of the needle tip and needle body. Consequently, the success rate of the initial puncture of the radial artery under ultrasound guidance remains somewhat restricted [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The depth of the artery from the skin can also impact the relationship between the puncture needle and the artery, leading to a decrease in the success rate of puncture catheterization [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, the complexity of ultrasound technology has hindered its widespread use, as it requires expertise to operate. As a result, blind puncture catheterization is still considered a dependable and often preferred method in clinical practice [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The use of ultrasound technology is only considered after repeated puncture and catheterization failures. At this time, the existing puncture injuries, vasospasm, and hematoma may greatly increase the difficulty of puncture and catheterization [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the presence of ultrasound technology, researchers both domestically and internationally have continued their efforts to improve the success rate of radial artery puncture and catheterization. Various methods have been explored, including increasing the diameter of the radial artery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], utilizing ultrasound probe marking[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], selecting the appropriate angle for the ultrasound probe[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], investigating new ultrasound technologies[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], employing laser-assisted technology[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and utilizing nerve block methods[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Ultrasound-guided radial artery puncture involves two main steps: puncture and catheterization. The primary challenge in both steps lies in accurately positioning the puncture needle within the arterial vessel and ensuring the stability of the needle core throughout the catheterization process. The current arterial puncture needle has no imaging effect, which also increases the difficulty of positioning the puncture needle under ultrasound, and the diameter of the radial artery is not large [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The puncture needle is too deep or too shallow, which may lead to the failure of catheterization. At the same time, it is regrettable that most operators usually abandon ultrasound during catheterization, which is completely blind catheterization. Ultrasound technology is more for the puncture process than the catheterization process, and the movement of the needle core caused by any reason All may lead to failure of catheterization. It is worth noting that the catheter can sense hemodynamic changes in the artery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and the slight depth change of the puncture needle can be monitored, which is also the basis of the invasive arterial waveform [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], so it can be predicted in advance. Connect the pressure sensor to observe the pressure waveform changes of the radial artery for judgment, and at the same time, it can be determined whether the punctured blood vessel is an artery.\u003c/p\u003e \u003cp\u003eTherefore, we propose a hypothesis, pre-connect the pressure sensor, observe the changes in the arterial pressure waveform, guide the puncture of the radial artery under ultrasound, and explore its impact on the first-time success rate of radial artery puncture.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Materials\u003c/h2\u003e \u003cp\u003eThe equipment used in this study included the Mindray TE7 color Doppler ultrasound system (Shenzhen Mindray Biomedical Electronics Co., Ltd.). Other supplies included a 1ml syringe, 5ml syringe, 500ml 0.9% sodium chloride injection, sterile gauze, Medical transparent dressing film, pressure sensor, heparin sodium injection, 20G Introcan-W puncture needle, sterile hole towel, sterile gloves, disposable sterile ultrasound probe protective cover, and medical ultrasound probe disinfection gel.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Methods\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Study design\u003c/h2\u003e \u003cp\u003eThis is an open single center randomized clinical trial conducted in the People's Hospital of Ganzhou City, China. This Randomized controlled trial was approved by the Ethics Committee of Ganzhou People's Hospital, with the consent letter No. TY-ZKY2023-019-01. Following the principles of the Declaration of Helsinki, Clinical trial registration (Registration No.: ChiCTR2400083806) was completed. all patients voluntarily signed the informed consent.\u003c/p\u003e \u003cp\u003eFrom March 2023 to July 2023, 82 ASAII-III patients undergoing elective gastrointestinal tumor surgery who were scheduled to undergo radial artery catheterization in the operating room of Ganzhou People's Hospital were selected and divided into two groups: pre connected pressure sensor puncture group (group P\u0026thinsp;=\u0026thinsp;38) and conventional ultrasound puncture group (group C\u0026thinsp;=\u0026thinsp;37). Inclusion criteria for this study included individuals aged 40 to 74 years old, with a negative result on the left hand modified ALLEN test, and without any signs of infection or trauma on the local skin of the left radial artery. Exclusion criteria comprised of the absence or malformation of the left radial artery, peripheral vascular disease of the left upper extremity, abnormal coagulation function. Cases that did not meet the inclusion criteria or did not undergo radial artery puncture as per the predetermined plan were excluded from the study. Additionally, participants who did not cooperate or voluntarily withdrew during the implementation process were considered drop-outs. Out of the initial 82 selected patients, only 75 met the inclusion criteria and were randomly divided into two groups: the experimental group (group P) with 38 cases and the control group (group C) with 37 cases. The random number table method was used for the allocation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Preparation before puncture\u003c/h2\u003e \u003cp\u003ePreparation before puncture, all patients underwent the modified Allen's test. A 20G Introcan-W puncture needle was selected and patients were positioned in a supine position, palms facing upwards, and wrists elevated. The wrist joints were maintained in a hyperextended state. Lidocaine was drawn from a 1ml syringe and injected. The solution was prepared by extracting 2500U of heparin sodium using a 5ml syringe and mixing it with 500ml of 0.9% sodium chloride injection to create a heparin sodium dilution of 2U/ml. The pressure sensor was connected and zeroed by exhausting it.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Puncture process\u003c/h2\u003e \u003cp\u003eBefore arterial puncture, povidone iodine was used for disinfection. and the center point was the strongest pulse of the radial artery 1 cm proximal to the radial styloid process, and the range was greater than 10 cm. After disinfection, a sterile drape was spread, and the same experienced anesthesiologist with a senior professional title performed radial artery puncture and catheterization in both groups. The puncturer wore gloves and applied gel to the high-frequency linear array ultrasound probe. The frequency range of the ultrasound probe was set at 5\u0026ndash;13 MHz, and the out-of-plane ultrasound technique was used. Once the puncture point was determined, the position of the probe was adjusted to ensure clear imaging of the radial artery at the center of the screen. Local anesthesia was administered with the assistance of ultrasound, followed by arterial puncture performed under ultrasound guidance. The needle shaft was maintained at an angle of 30\u0026ndash;45\u0026deg; to the skin. Before performing the puncture in group P, Connect the pressure sensor to the puncture needle. After that, the zero should be adjusted again to exhaust the air. During the puncture, ensure that the needle tip is positioned in the middle of the arterial vessel. Depress the puncture needle handle and continue advancing the needle for approximately 0.5cm. Fine-tune the position until a continuous pattern is displayed on the monitor. Arterial catheterization should only be performed when the needle tip remains in the center of the arterial vessel. Ultrasound guidance is not used during the catheterization process. The right hand should keep the needle core steady, while the left hand maintains continuous and regular arterial waveforms on the monitor throughout the catheterization process. If the continuous and regular arterial waveform cannot be maintained, adjustments should be stopped until the waveform is restored. Once the catheter is successfully placed, the needle core connected to the pressure sensor should be removed and the sensor should be connected to the catheter. If the catheter placement is unsuccessful, the puncture will continue to be attempted in the same manner until it is successful or the maximum number of attempts is reached as prescribed (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In group C, the radial artery puncture was performed directly under ultrasound guidance, without pre-connection of the pressure sensor. When the needle tip reached the center of the artery, the needle handle was depressed, and the needle continued to advance for about 0.5 cm. Blood returned from the puncture needle. Fine-tuning the needle saw blood return or The puncture needle has been filled with blood but the needle tip is still in the middle of the arterial vessel under ultrasound, At this point, allowing for the insertion of the catheter with the left hand while the needle core was fixed with the right hand. Ultrasound guidance was not used during the catheterization process. If the catheter was successfully placed, it could be connected to the sensor. If not successful, the radial artery puncture procedure would be repeated in the same manner until success or until the prescribed number of punctures was exceeded (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After successful puncture, patients in both groups were secured with a Medical transparent dressing film to fix the puncture needle catheter. Invasive arterial pressure monitoring could then be performed after calibration and exhaust. All patients were required to record the number of radial artery punctures. If catheterization was unsuccessful after three punctures, it was considered a failure and no further punctures were attempted [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The time from the first puncture needle piercing the skin to successful catheterization was recorded. Additionally, the time between the first puncture needle piercing the skin and the third catheterization failure was noted. The VAS score of radial artery puncture pain, as well as the first success rate and the failure rate, were also recorded.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Observation indexes\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the success rate of radial artery puncture for the first time in two groups of patients. The research also examined secondary indicators such as the frequency and time of radial artery puncture, failure rate, pain VAS score, incidence of vasospasm, and incidence of subcutaneous hematoma in the two groups. Additionally, the diameter, depth of radial artery at the puncture point, and PI (Perfusion Index) of the thumb on the puncture side were measured in both groups. General information including age, gender, height, weight, body temperature, preoperative platelets, preoperative hemoglobin values, mean arterial pressure, heart rate, ASA classification, surgical site, and oxygen saturation were recorded for both groups of patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Sample size and statistical analysis\u003c/h2\u003e \u003cp\u003eBased on the previous pre-experiment, the success rate of radial artery puncture for the first time in group P was 90%, whereas in group C it was 62%, as reported in the existing literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Assuming a type I error of 0.05 and an efficacy of 0.80, a minimum research sample size of 66 individuals was calculated. To account for potential eliminations due to changes in clinical status, a total of 82 patients were initially recruited for the study. Categorical data were represented as numbers or percentages, while quantitative data exhibiting a normal distribution were presented as means and standard deviations. Parametric tests were employed for data with a normal distribution, whereas nonparametric tests were utilized for data without a normal distribution. Categorical data were analyzed using Chi-square tests and Fisher's probability. A p-value of less than 0.05 was considered statistically significant. All data were analyzed using the Statistical Package for the Social Sciences 23.0 (SPSS 23.0).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":" \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study population\u003c/h2\u003e \u003cp\u003eThere was no significant difference between the two groups in age, gender, height, weight, PLT, Hb, MAP, HR, ASA, SPO\u003csub\u003e2\u003c/sub\u003e (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and perioperative characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup P\u003c/p\u003e \u003cp\u003e(n=38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003cp\u003e(n=37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.578\u0026thinsp;\u0026plusmn;\u0026thinsp;7.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.027\u0026thinsp;\u0026plusmn;\u0026thinsp;7.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162.368\u0026thinsp;\u0026plusmn;\u0026thinsp;8.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161.783\u0026thinsp;\u0026plusmn;\u0026thinsp;7.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight(kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.684\u0026thinsp;\u0026plusmn;\u0026thinsp;12.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.797\u0026thinsp;\u0026plusmn;\u0026thinsp;12.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT(10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232.973\u0026thinsp;\u0026plusmn;\u0026thinsp;62.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e226.297\u0026thinsp;\u0026plusmn;\u0026thinsp;59.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117.526\u0026thinsp;\u0026plusmn;\u0026thinsp;16.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119.081\u0026thinsp;\u0026plusmn;\u0026thinsp;16.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP(mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.657\u0026thinsp;\u0026plusmn;\u0026thinsp;9.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.891\u0026thinsp;\u0026plusmn;\u0026thinsp;8.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR(bmp)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.842\u0026thinsp;\u0026plusmn;\u0026thinsp;8.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.973\u0026thinsp;\u0026plusmn;\u0026thinsp;8.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA II/III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31/6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPO\u003csub\u003e2\u003c/sub\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.973\u0026thinsp;\u0026plusmn;\u0026thinsp;1.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.891\u0026thinsp;\u0026plusmn;\u0026thinsp;1.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePLT, Platelet; Hb, Hemoglobin; MAP, Mean arterial pressure; HR, heart rate; ASA, American Society of Anesthesiologists.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 secondary outcomes\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference between the two groups of patients in the diameter, depth, and PI of the radial artery at the puncture point during radial artery puncture (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The average number of radial artery punctures in group P and group C were 1.210 and 1.567, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the median puncture time was 30s and 35s, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The failure rates of arterial puncture in the two groups were 5.26% and 13.51%, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The incidence of subcutaneous hematoma caused by radial artery puncture in Group P and Group C was 10.52% and 32.43%, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the average VAS score of pain during puncture was 1.894 and 2.621, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), all of which were statistically significant. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003esecondary, and post hoc outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup P\u003c/p\u003e \u003cp\u003e(n=38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003cp\u003e(n=37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT/χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary outcomes\u003c/p\u003e \u003cp\u003eDiameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.947\u0026thinsp;\u0026plusmn;\u0026thinsp;3.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.405\u0026thinsp;\u0026plusmn;\u0026thinsp;3.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepth (mm)\u003c/p\u003e \u003cp\u003ePI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.000\u0026thinsp;\u0026plusmn;\u0026thinsp;5.422\u003c/p\u003e \u003cp\u003e4.527\u0026thinsp;\u0026plusmn;\u0026thinsp;1.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.621\u0026thinsp;\u0026plusmn;\u0026thinsp;7.994\u003c/p\u003e \u003cp\u003e5.065\u0026thinsp;\u0026plusmn;\u0026thinsp;1.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.511\u003c/p\u003e \u003cp\u003e-1.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage puncture times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.210\u0026thinsp;\u0026plusmn;\u0026thinsp;0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.567\u0026thinsp;\u0026plusmn;\u0026thinsp;0.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage puncture time (s), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.0(25.0-36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0(28.5\u0026ndash;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuncture failure rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/38(5.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/37(13.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esubcutaneous hematoma (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/38(10.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/37(32.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePI, Perfusion Index ; VAS, Visual Analogue Scale ; IQR, interquartile range\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Primary outcomes\u003c/h2\u003e \u003cp\u003eThe success rates of the first radial artery puncture in Group P and Group C were 86.84% and 67.56%, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the difference was also statistically significant. (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aims to investigate the impact of pre-connecting a pressure sensor to the puncture needle on the success rate of ultrasound-guided radial artery puncture and catheterization in patients with gastrointestinal tumors. The objective is to assist anesthesiologists in improving their performance of ultrasound-guided radial artery puncture during tube surgery. The study results showed that the success rate of initial radial artery puncture in group P was significantly higher (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared to group C.\u003c/p\u003e \u003cp\u003eIn evaluating the radial artery puncture process of two groups of patients, it was observed that the P group had a lower number of punctures compared to the C group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), and there was no difference in the comparison of the puncture and catheterization time between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05), suggesting that the new technology does not result in longer procedure time due to lack of proficiency. This indicates that the technology is highly reproducible and easy to understand. Regarding the failure rate of catheterization, although the P group had a lower failure rate compared to the C group, the difference was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This finding is consistent with the low clinical reality of failure rate in radial artery catheterization under ultrasound. In summary, it can be seen that patients in group P had fewer local anesthesia due to failure of puncture catheterization. Some studies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] have shown that local anesthesia with lidocaine before radial artery puncture may have caused higher pain. the incidence of vasospasm, and repeated use of lidocaine may lead to tolerance, poor analgesic effect, and may also reduce the success rate of radial artery puncture and catheterization. At the same time, the complications of subcutaneous hematoma and pain in patients in group P were significantly reduced (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), which was also related to a higher success rate of arterial puncture and catheterization[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Patients suffer less pain from radial artery puncture and have a higher degree of cooperation, which may also increase the success rate of puncture and catheterization.\u003c/p\u003e \u003cp\u003eImproving the success rate of radial artery puncture catheterization under ultrasound is a pressing issue that needs to be addressed scientifically. Although a study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] has utilized in-plane and out-of-plane ultrasound techniques to enhance the accuracy of needle placement, the combined use of these two techniques may result in more intricate ultrasound applications. However, it needs to be clarified that the purpose of puncture catheterization is to obtain continuous arterial pressure monitoring and blood gas analysis at any time. The purpose of puncture catheterization is to obtain continuous arterial pressure monitoring and blood gas analysis. However, during the puncture process, it is difficult to immediately determine the position of the puncture needle after it enters the blood vessel. This often leads to the arterial blood instantly filling the puncture needle and difficultly judge whether the puncture needle is in the artery by returning blood [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. and the needle core needs to be kept still during the catheterization process, so the operator needs both hands to perform the catheterization process, At this point, there is no extra hand to control the ultrasound probe. In order to reduce manpower output, most people choose to abandon ultrasound for blind catheterization, At this time, whether the needle core is stable in the artery is often the key factor for successful catheterization. The function of the pressure sensor is to sense hemodynamic changes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It generates regular arterial waveforms and continuous invasive arterial pressure values on the monitor. Additionally, it can monitor the position of the puncture needle and the arterial vessel, providing continuous and objective monitoring. Previous studies have confirmed that changes in the blood pressure waveform can guide the placement of the Swan-Ganz floating catheter [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Therefore, this feature allows for pre-connection of the pressure sensor with the puncture needle in advance. This aids ultrasound in determining the position of the puncture needle and provides continuous assistance for radial artery puncture, both with and without ultrasound guidance.\u003c/p\u003e \u003cp\u003eThe study has certain limitations that should be acknowledged. Firstly, our inclusion criteria excluded patients with abnormal coagulation function, and there is a lack of research on patients with coagulation dysfunction. Therefore, further exploration is needed to determine the applicability of the conclusions of this study to patients with coagulation dysfunction. Additionally, there may be variations in evaluation due to different pain thresholds among patients during radial artery puncture, which could potentially influence the pain score.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWhen performing radial artery puncture and catheterization in patients with gastrointestinal tumors, the use of pre-connected pressure sensors can enhance the success rate of radial artery puncture and catheterization under ultrasound guidance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u003c/strong\u003e\u0026mdash;the authors would like to thank all the reviewers who participated in the review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions.\u003c/strong\u003e\u0026mdash;All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e\u0026mdash;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u003c/strong\u003e\u0026mdash;The datasets generated and/or analyzed during the current study are not publicly available before publication of our study, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest.\u003c/strong\u003e\u0026mdash;The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLee SM, Lee G, Kim TK, Le T, Hao J, Jung YM, Park CW, Park JS, Jun JK, Lee HC, Kim D. 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Biomed Eng Online. 2010 Jan 21;9:6. \u003c/li\u003e\n\u003cli\u003eLanger T, Vecchi V, Belenkiy SM, Cancio LC, Gattinoni L, Batchinsky AI. Pressure-guided positioning of bicaval dual-lumen catheters for venovenous extracorporeal gas exchange. Intensive Care Med. 2013 Jan;39(1):151-4.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pressure sensor, radial artery puncture, gastrointestinal tumors, ultrasound, radial artery catheterization","lastPublishedDoi":"10.21203/rs.3.rs-4427025/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4427025/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eOBJECTIVE\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aims to investigate the impact of pre-connecting pressure transducers on the efficacy of ultrasound-guided radial artery puncture and catheterization in patients with gastrointestinal tumors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSeventy-five eligible patients undergoing elective gastrointestinal tumor surgery were randomly divided into two groups: the pre-connected pressure sensor puncture group (group P\u0026thinsp;=\u0026thinsp;38) and the conventional puncture group (group C\u0026thinsp;=\u0026thinsp;37). The patients' vital signs were monitored upon entering the room, and a senior anesthesiologist performed the radial artery puncture and catheterization for both groups. The radial artery puncture catheterization was guided by ultrasound in both groups, Prior to the puncture, patients in group P were pre-connected to the pressure sensor. After zeroing and exhausting, the radial artery puncture catheter was performed under ultrasound guidance. with group C undergoing direct ultrasound-guided puncture catheterization. The success rate of first puncture catheterization, puncture time, puncture times, and puncture failure rate were recorded.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResult\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe success rate of radial artery catheterization on the first attempt was significantly higher in group P compared to group C (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, group P demonstrated a decrease in both arterial punctures and VAS pain scores. (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePre-connecting a pressure sensor when performing radial artery puncture and catheterization in patients with gastrointestinal tumors can enhance the success rate of radial artery puncture and catheterization under ultrasound guidance.\u003c/p\u003e","manuscriptTitle":"Exploring the effect of pre-connected pressure sensor on ultrasound-guided radial artery puncture in patients with gastrointestinal tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 02:46:51","doi":"10.21203/rs.3.rs-4427025/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c8bc7ce1-e3ad-4d4c-b1a9-24d3d5618524","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T09:03:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 02:46:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4427025","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4427025","identity":"rs-4427025","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}